In developing countries, endemic childhood meningitis is a severe disease caused most commonly by
Streptococcus pneumoniae or Haemophilus influenzae type b (Hib). Although many studies have shown that
fatality rates associated with meningitis caused by these organisms are high in developing countries, little is
known about the long-term outcome of survivors. The purpose of this study was to assess the importance of
disabilities following pneumococcal and Hib meningitis in The Gambia. 257 children aged 0–12 years
hospitalized between 1990 and 1995 with culture-proven S. pneumoniae (n 5 134) or Hib (n 5 123)
meningitis were included retrospectively in the study. 48% of children with pneumococcal meningitis and
27% of children with Hib meningitis died whilst in hospital. Of the 160 survivors, 89 (55%) were followed
up between September 1996 and October 1997. Of the children with pneumococcal meningitis that were
traced, 58% had clinical sequelae; half of them had major disabilities preventing normal adaptation to social
life. 38% of survivors of Hib meningitis had clinical sequelae, a quarter of whom had major disabilities.
Major handicaps found were hearing loss, mental retardation, motor abnormalities and seizures. These data
show that despite treatment with effective antibiotics, pneumococcal and Hib meningitis kill many Gambian
children and leave many survivors with severe sequelae. Hib vaccination is now given routinely in The
Gambia; an effective pneumococcal vaccine is needed.